la How Long Do Potatoes Last? Raw, Cooked, and More By www.medicinenet.com Published On :: Fri, 26 Aug 2022 00:00:00 PDT Title: How Long Do Potatoes Last? Raw, Cooked, and MoreCategory: Health and LivingCreated: 8/26/2022 12:00:00 AMLast Editorial Review: 8/26/2022 12:00:00 AM Full Article
la Does Hot Chocolate Have Caffeine? Hot Chocolate vs. Coffee & Tea By www.medicinenet.com Published On :: Fri, 26 Aug 2022 00:00:00 PDT Title: Does Hot Chocolate Have Caffeine? Hot Chocolate vs. Coffee & TeaCategory: Health and LivingCreated: 8/26/2022 12:00:00 AMLast Editorial Review: 8/26/2022 12:00:00 AM Full Article
la U.S. Government Extends Baby Formula Waivers, Rebates for WIC Families By www.medicinenet.com Published On :: Sat, 27 Aug 2022 00:00:00 PDT Title: U.S. Government Extends Baby Formula Waivers, Rebates for WIC FamiliesCategory: Health NewsCreated: 8/25/2022 12:00:00 AMLast Editorial Review: 8/26/2022 12:00:00 AM Full Article
la Are Plant Sterols Good for Lowering Cholesterol? By www.medicinenet.com Published On :: Thu, 12 May 2022 00:00:00 PDT Title: Are Plant Sterols Good for Lowering Cholesterol?Category: Diseases and ConditionsCreated: 5/12/2022 12:00:00 AMLast Editorial Review: 5/12/2022 12:00:00 AM Full Article
la Mental Health Issues Can Plague Families of Kids With Type 1 Diabetes By www.medicinenet.com Published On :: Fri, 5 Aug 2022 00:00:00 PDT Title: Mental Health Issues Can Plague Families of Kids With Type 1 DiabetesCategory: Health NewsCreated: 8/5/2022 12:00:00 AMLast Editorial Review: 8/5/2022 12:00:00 AM Full Article
la Fecal Transplant Treatments Could Transmit Monkeypox, FDA Warns By www.medicinenet.com Published On :: Thu, 25 Aug 2022 00:00:00 PDT Title: Fecal Transplant Treatments Could Transmit Monkeypox, FDA WarnsCategory: Health NewsCreated: 8/24/2022 12:00:00 AMLast Editorial Review: 8/25/2022 12:00:00 AM Full Article
la Playing Football, Hockey in High School Ups Odds for Stimulant Abuse By www.medicinenet.com Published On :: Mon, 15 Aug 2022 00:00:00 PDT Title: Playing Football, Hockey in High School Ups Odds for Stimulant AbuseCategory: Health NewsCreated: 8/15/2022 12:00:00 AMLast Editorial Review: 8/15/2022 12:00:00 AM Full Article
la Will Inflation Cut Back on Your Health Care? By www.medicinenet.com Published On :: Mon, 8 Aug 2022 00:00:00 PDT Title: Will Inflation Cut Back on Your Health Care?Category: Health NewsCreated: 8/8/2022 12:00:00 AMLast Editorial Review: 8/8/2022 12:00:00 AM Full Article
la Here's How New Federal Legislation Might Cut Your Drug Costs By www.medicinenet.com Published On :: Mon, 15 Aug 2022 00:00:00 PDT Title: Here's How New Federal Legislation Might Cut Your Drug CostsCategory: Health NewsCreated: 8/12/2022 12:00:00 AMLast Editorial Review: 8/15/2022 12:00:00 AM Full Article
la Here's How the Inflation Reduction Act Will Lower the Cost of Health Care By www.medicinenet.com Published On :: Wed, 17 Aug 2022 00:00:00 PDT Title: Here's How the Inflation Reduction Act Will Lower the Cost of Health CareCategory: Health NewsCreated: 8/17/2022 12:00:00 AMLast Editorial Review: 8/17/2022 12:00:00 AM Full Article
la Helmets Protect Young Lacrosse Players, Study Finds By www.medicinenet.com Published On :: Thu, 25 Aug 2022 00:00:00 PDT Title: Helmets Protect Young Lacrosse Players, Study FindsCategory: Health NewsCreated: 8/25/2022 12:00:00 AMLast Editorial Review: 8/25/2022 12:00:00 AM Full Article
la Too Few U.S. Cities Have Good Hurricane Evacuation Plans By www.medicinenet.com Published On :: Fri, 26 Aug 2022 00:00:00 PDT Title: Too Few U.S. Cities Have Good Hurricane Evacuation PlansCategory: Health NewsCreated: 8/26/2022 12:00:00 AMLast Editorial Review: 8/26/2022 12:00:00 AM Full Article
la Lamisil (terbinafine) vs. Lotrimin (clotrimazole) By www.medicinenet.com Published On :: Wed, 10 Aug 2022 00:00:00 PDT Title: Lamisil (terbinafine) vs. Lotrimin (clotrimazole) Category: MedicationsCreated: 6/10/2019 12:00:00 AMLast Editorial Review: 8/10/2022 12:00:00 AM Full Article
la Prostatitis (Inflammation of the Prostate Gland) By www.medicinenet.com Published On :: Fri, 29 Jul 2022 00:00:00 PDT Title: Prostatitis (Inflammation of the Prostate Gland) Category: Diseases and ConditionsCreated: 12/31/1997 12:00:00 AMLast Editorial Review: 7/29/2022 12:00:00 AM Full Article
la What Are the 5 Warning Signs of Bladder Cancer? By www.medicinenet.com Published On :: Wed, 8 Jun 2022 00:00:00 PDT Title: What Are the 5 Warning Signs of Bladder Cancer?Category: Diseases and ConditionsCreated: 4/22/2021 12:00:00 AMLast Editorial Review: 6/8/2022 12:00:00 AM Full Article
la What Therapeutic Options Are Available for Treating an Antiretroviral Naive Patient? By www.medicinenet.com Published On :: Thu, 16 Jun 2022 00:00:00 PDT Title: What Therapeutic Options Are Available for Treating an Antiretroviral Naive Patient?Category: Diseases and ConditionsCreated: 6/16/2022 12:00:00 AMLast Editorial Review: 6/16/2022 12:00:00 AM Full Article
la Experimental Drug May Ease Hot Flashes By www.medicinenet.com Published On :: Tue, 14 Jun 2022 00:00:00 PDT Title: Experimental Drug May Ease Hot FlashesCategory: Health NewsCreated: 6/13/2022 12:00:00 AMLast Editorial Review: 6/14/2022 12:00:00 AM Full Article
la Early Menopause Could Mean More Heart Trouble Later By www.medicinenet.com Published On :: Mon, 8 Aug 2022 00:00:00 PDT Title: Early Menopause Could Mean More Heart Trouble LaterCategory: Health NewsCreated: 8/8/2022 12:00:00 AMLast Editorial Review: 8/8/2022 12:00:00 AM Full Article
la Scotland Becomes 1st Country to Provide Free Period Products By www.medicinenet.com Published On :: Tue, 16 Aug 2022 00:00:00 PDT Title: Scotland Becomes 1st Country to Provide Free Period ProductsCategory: Health NewsCreated: 8/15/2022 12:00:00 AMLast Editorial Review: 8/16/2022 12:00:00 AM Full Article
la Metronidazole (Flagyl) vs. Fluconazole (Diflucan) By www.medicinenet.com Published On :: Wed, 24 Aug 2022 00:00:00 PDT Title: Metronidazole (Flagyl) vs. Fluconazole (Diflucan)Category: MedicationsCreated: 11/27/2018 12:00:00 AMLast Editorial Review: 8/24/2022 12:00:00 AM Full Article
la MS (Multiple Sclerosis) vs. ALS (Amyotrophic Lateral Sclerosis) By www.medicinenet.com Published On :: Thu, 4 Aug 2022 00:00:00 PDT Title: MS (Multiple Sclerosis) vs. ALS (Amyotrophic Lateral Sclerosis)Category: Diseases and ConditionsCreated: 6/16/2017 12:00:00 AMLast Editorial Review: 8/4/2022 12:00:00 AM Full Article
la Is Chlamydia Contagious? By www.medicinenet.com Published On :: Mon, 1 Aug 2022 00:00:00 PDT Title: Is Chlamydia Contagious?Category: Diseases and ConditionsCreated: 5/28/2015 12:00:00 AMLast Editorial Review: 8/1/2022 12:00:00 AM Full Article
la Vaccines Have Slashed Rates of HPV Infection in Young American Women By www.medicinenet.com Published On :: Tue, 23 Aug 2022 00:00:00 PDT Title: Vaccines Have Slashed Rates of HPV Infection in Young American WomenCategory: Health NewsCreated: 8/22/2022 12:00:00 AMLast Editorial Review: 8/23/2022 12:00:00 AM Full Article
la Vaginal or C-Section, Method of Childbirth Won't Affect a Couple's Sex Life Later By www.medicinenet.com Published On :: Thu, 25 Aug 2022 00:00:00 PDT Title: Vaginal or C-Section, Method of Childbirth Won't Affect a Couple's Sex Life LaterCategory: Health NewsCreated: 8/24/2022 12:00:00 AMLast Editorial Review: 8/25/2022 12:00:00 AM Full Article
la Cyclobenzaprine vs. Xanax (alprazolam) By www.medicinenet.com Published On :: Thu, 25 Aug 2022 00:00:00 PDT Title: Cyclobenzaprine vs. Xanax (alprazolam)Category: MedicationsCreated: 6/6/2019 12:00:00 AMLast Editorial Review: 8/25/2022 12:00:00 AM Full Article
la When Hospital Patient & Doctor Speak Same Language, Outcomes Improve By www.medicinenet.com Published On :: Mon, 11 Jul 2022 00:00:00 PDT Title: When Hospital Patient & Doctor Speak Same Language, Outcomes ImproveCategory: Health NewsCreated: 7/11/2022 12:00:00 AMLast Editorial Review: 7/11/2022 12:00:00 AM Full Article
la Picture of Nickel Contact Dermatitis from Necklace By www.medicinenet.com Published On :: Tue, 28 Jun 2022 00:00:00 PDT Title: Picture of Nickel Contact Dermatitis from NecklaceCategory: ImagesCreated: 2/22/2010 3:21:00 PMLast Editorial Review: 6/28/2022 12:00:00 AM Full Article
la Salicylate Sensitivity Causes, Symptoms, and Foods to Avoid By www.medicinenet.com Published On :: Fri, 8 Jul 2022 00:00:00 PDT Title: Salicylate Sensitivity Causes, Symptoms, and Foods to AvoidCategory: Health and LivingCreated: 7/8/2022 12:00:00 AMLast Editorial Review: 7/8/2022 12:00:00 AM Full Article
la Health Care Plans Keep Allergy Rescue Injectors Pricey for Some By www.medicinenet.com Published On :: Fri, 15 Jul 2022 00:00:00 PDT Title: Health Care Plans Keep Allergy Rescue Injectors Pricey for SomeCategory: Health NewsCreated: 7/15/2022 12:00:00 AMLast Editorial Review: 7/15/2022 12:00:00 AM Full Article
la Prehistoric People Drank Animal Milk, Despite Lactose Intolerance By www.medicinenet.com Published On :: Thu, 28 Jul 2022 00:00:00 PDT Title: Prehistoric People Drank Animal Milk, Despite Lactose IntoleranceCategory: Health NewsCreated: 7/27/2022 12:00:00 AMLast Editorial Review: 7/28/2022 12:00:00 AM Full Article
la gotu kola By www.medicinenet.com Published On :: Thu, 18 Aug 2022 00:00:00 PDT Title: gotu kolaCategory: MedicationsCreated: 8/18/2022 12:00:00 AMLast Editorial Review: 8/18/2022 12:00:00 AM Full Article
la Is Laryngitis Contagious? By www.medicinenet.com Published On :: Fri, 22 Jul 2022 00:00:00 PDT Title: Is Laryngitis Contagious?Category: Diseases and ConditionsCreated: 9/10/2015 12:00:00 AMLast Editorial Review: 7/22/2022 12:00:00 AM Full Article
la Study Casts Doubt on 'Chemical Imbalance' Theory of Depression By www.medicinenet.com Published On :: Tue, 9 Aug 2022 00:00:00 PDT Title: Study Casts Doubt on 'Chemical Imbalance' Theory of DepressionCategory: Health NewsCreated: 8/9/2022 12:00:00 AMLast Editorial Review: 8/9/2022 12:00:00 AM Full Article
la Treating central sleep apnoea in heart failure: is positive airway pressure and adaptive servo-ventilation in particular the gold standard? By err.ersjournals.com Published On :: 2024-10-30T01:30:15-07:00 Extract We read with great interest the review article by Randerath et al. [1] recently published in the European Respiratory Review. We would like to congratulate the authors on this clearly structured review, which emphasises the urgent need for an increasingly differentiated view of central sleep apnoea (CSA) in the context of precision medicine. Full Article
la The deadly dance of alveolar macrophages and influenza virus By err.ersjournals.com Published On :: 2024-10-30T01:30:15-07:00 Influenza A virus (IAV) is one of the leading causes of respiratory infections. The lack of efficient anti-influenza therapeutics requires a better understanding of how IAV interacts with host cells. Alveolar macrophages are tissue-specific macrophages that play a critical role in lung innate immunity and homeostasis, yet their role during influenza infection remains unclear. First, our review highlights an active IAV replication within alveolar macrophages, despite an abortive viral cycle. Such infection leads to persistent alveolar macrophage inflammation and diminished phagocytic function, alongside direct mitochondrial damage and indirect metabolic shifts in the alveolar micro-environment. We also discuss the "macrophage disappearance reaction", which is a drastic reduction of the alveolar macrophage population observed after influenza infection in mice but debated in humans, with unclear underlying mechanisms. Furthermore, we explore the dual nature of alveolar macrophage responses to IAV infection, questioning whether they are deleterious or protective for the host. While IAV may exploit immuno-evasion strategies and induce alveolar macrophage alteration or depletion, this could potentially reduce excessive inflammation and allow for the replacement of more effective cells. Despite these insights, the pathophysiological role of alveolar macrophages during IAV infection in humans remains understudied, urging further exploration to unravel their precise contributions to disease progression and resolution. Full Article
la Dynamic dysregulation of retrotransposons in neurodegenerative diseases at the single-cell level [RESOURCES] By genome.cshlp.org Published On :: 2024-10-29T06:46:08-07:00 Retrotransposable elements (RTEs) are common mobile genetic elements comprising ~42% of the human genome. RTEs play critical roles in gene regulation and function, but how they are specifically involved in complex diseases is largely unknown. Here, we investigate the cellular heterogeneity of RTEs using 12 single-cell transcriptome profiles covering three neurodegenerative diseases, Alzheimer's disease (AD), Parkinson's disease, and multiple sclerosis. We identify cell type marker RTEs in neurons, astrocytes, oligodendrocytes, and oligodendrocyte precursor cells that are related to these diseases. The differential expression analysis reveals the landscape of dysregulated RTE expression, especially L1s, in excitatory neurons of multiple neurodegenerative diseases. Machine learning algorithms for predicting cell disease stage using a combination of RTE and gene expression features suggests dynamic regulation of RTEs in AD. Furthermore, we construct a single-cell atlas of retrotransposable elements in neurodegenerative disease (scARE) using these data sets and features. scARE has six feature analysis modules to explore RTE dynamics in a user-defined condition. To our knowledge, scARE represents the first systematic investigation of RTE dynamics at the single-cell level within the context of neurodegenerative diseases. Full Article
la Rapid SARS-CoV-2 surveillance using clinical, pooled, or wastewater sequence as a sensor for population change [METHODS] By genome.cshlp.org Published On :: 2024-10-29T06:46:08-07:00 The COVID-19 pandemic has highlighted the critical role of genomic surveillance for guiding policy and control. Timeliness is key, but sequence alignment and phylogeny slow most surveillance techniques. Millions of SARS-CoV-2 genomes have been assembled. Phylogenetic methods are ill equipped to handle this sheer scale. We introduce a pangenomic measure that examines the information diversity of a k-mer library drawn from a country's complete set of clinical, pooled, or wastewater sequence. Quantifying diversity is central to ecology. Hill numbers, or the effective number of species in a sample, provide a simple metric for comparing species diversity across environments. The more diverse the sample, the higher the Hill number. We adopt this ecological approach and consider each k-mer an individual and each genome a transect in the pangenome of the species. Structured in this way, Hill numbers summarize the temporal trajectory of pandemic variants, collapsing each day's assemblies into genome equivalents. For pooled or wastewater sequence, we instead compare days using survey sequence divorced from individual infections. Across data from the UK, USA, and South Africa, we trace the ascendance of new variants of concern as they emerge in local populations well before these variants are named and added to phylogenetic databases. Using data from San Diego wastewater, we monitor these same population changes from raw, unassembled sequence. This history of emerging variants senses all available data as it is sequenced, intimating variant sweeps to dominance or declines to extinction at the leading edge of the COVID-19 pandemic. Full Article
la Global characterization of somatic mutations and DNA methylation changes during vegetative propagation in strawberries [RESEARCH] By genome.cshlp.org Published On :: 2024-10-29T06:46:07-07:00 Somatic mutations arise and accumulate during tissue culture and vegetative propagation, potentially affecting various traits in horticultural crops, but their characteristics are still unclear. Here, somatic mutations in regenerated woodland strawberry derived from tissue culture of shoot tips under different conditions and 12 cultivated strawberry individuals are analyzed by whole genome sequencing. The mutation frequency of single nucleotide variants is significantly increased with increased hormone levels or prolonged culture time in the range of 3.3 x 10–8–3.0 x 10–6 mutations per site. CG methylation shows a stable reduction (0.71%–8.03%) in regenerated plants, and hypoCG-DMRs are more heritable after sexual reproduction. A high-quality haplotype-resolved genome is assembled for the strawberry cultivar "Beni hoppe." The 12 "Beni hoppe" individuals randomly selected from different locations show 4731–6005 mutations relative to the reference genome, and the mutation frequency varies among the subgenomes. Our study has systematically characterized the genetic and epigenetic variants in regenerated woodland strawberry plants and different individuals of the same strawberry cultivar, providing an accurate assessment of somatic mutations at the genomic scale and nucleotide resolution in plants. Full Article
la Evolutionary dynamics of polyadenylation signals and their recognition strategies in protists [RESEARCH] By genome.cshlp.org Published On :: 2024-10-29T06:46:07-07:00 The poly(A) signal, together with auxiliary elements, directs cleavage of a pre-mRNA and thus determines the 3' end of the mature transcript. In many species, including humans, the poly(A) signal is an AAUAAA hexamer, but we recently found that the deeply branching eukaryote Giardia lamblia uses a distinct hexamer (AGURAA) and lacks any known auxiliary elements. Our discovery prompted us to explore the evolutionary dynamics of poly(A) signals and auxiliary elements in the eukaryotic kingdom. We use direct RNA sequencing to determine poly(A) signals for four protists within the Metamonada clade (which also contains G. lamblia) and two outgroup protists. These experiments reveal that the AAUAAA hexamer serves as the poly(A) signal in at least four different eukaryotic clades, indicating that it is likely the ancestral signal, whereas the unusual Giardia version is derived. We find that the use and relative strengths of auxiliary elements are also plastic; in fact, within Metamonada, species like G. lamblia make use of a previously unrecognized auxiliary element where nucleotides flanking the poly(A) signal itself specify genuine cleavage sites. Thus, despite the fundamental nature of pre-mRNA cleavage for the expression of all protein-coding genes, the motifs controlling this process are dynamic on evolutionary timescales, providing motivation for future biochemical and structural studies as well as new therapeutic angles to target eukaryotic pathogens. Full Article
la Mutational scanning of CRX classifies clinical variants and reveals biochemical properties of the transcriptional effector domain [RESEARCH] By genome.cshlp.org Published On :: 2024-10-29T06:46:07-07:00 The transcription factor (TF) cone-rod homeobox (CRX) is essential for the differentiation and maintenance of photoreceptor cell identity. Several human CRX variants cause degenerative retinopathies, but most are variants of uncertain significance. We performed a deep mutational scan (DMS) of nearly all possible single amino acid substitutions in CRX using a cell-based transcriptional reporter assay, curating a high-confidence list of nearly 2000 variants with altered transcriptional activity. In the structured homeodomain, activity scores closely aligned to a predicted structure and demonstrated position-specific constraints on amino acid substitution. In contrast, the intrinsically disordered transcriptional effector domain displayed a qualitatively different pattern of substitution effects, following compositional constraints without specific residue position requirements in the peptide chain. These compositional constraints were consistent with the acidic exposure model of transcriptional activation. We evaluated the performance of the DMS assay as a clinical variant classification tool using gold-standard classified human variants from ClinVar, identifying pathogenic variants with high specificity and moderate sensitivity. That this performance could be achieved using a synthetic reporter assay in a foreign cell type, even for a highly cell type-specific TF like CRX, suggests that this approach shows promise for DMS of other TFs that function in cell types that are not easily accessible. Together, the results of the CRX DMS identify molecular features of the CRX effector domain and demonstrate utility for integration into the clinical variant classification pipeline. Full Article
la Evidence for compensatory evolution within pleiotropic regulatory elements [RESEARCH] By genome.cshlp.org Published On :: 2024-10-29T06:46:07-07:00 Pleiotropy, measured as expression breadth across tissues, is one of the best predictors for protein sequence and expression conservation. In this study, we investigated its effect on the evolution of cis-regulatory elements (CREs). To this end, we carefully reanalyzed the Epigenomics Roadmap data for nine fetal tissues, assigning a measure of pleiotropic degree to nearly half a million CREs. To assess the functional conservation of CREs, we generated ATAC-seq and RNA-seq data from humans and macaques. We found that more pleiotropic CREs exhibit greater conservation in accessibility, and the mRNA expression levels of the associated genes are more conserved. This trend of higher conservation for higher degrees of pleiotropy persists when analyzing the transcription factor binding repertoire. In contrast, simple DNA sequence conservation of orthologous sites between species tends to be even lower for pleiotropic CREs than for species-specific CREs. Combining various lines of evidence, we propose that the lack of sequence conservation in functionally conserved pleiotropic CREs is owing to within-element compensatory evolution. In summary, our findings suggest that pleiotropy is also a good predictor for the functional conservation of CREs, even though this is not reflected in the sequence conservation of pleiotropic CREs. Full Article
la Only One Quarter of Family Physicians Are Very Satisfied with Their Electronic Health Records Platform By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Two decades into the era of Electronic Health Records (EHRs), the promise of streamlining clinical care, reducing burden, and improving patient outcomes has yet to be realized. A cross-sectional family physician census conducted by the American Board of Family Medicine in 2022 and 2023 included self-reported physician EHR satisfaction. Of the nearly 10,000 responding family physicians, only one-in-four (26.2%) report being very satisfied and one-in-three (33.8%) were not satisfied. These low levels of satisfaction point to the need for greater transparency in the marketplace and pressure to increase user-centric EHR design. Full Article
la Impact of COVID-19 on Chronic Ambulatory-Care-Sensitive Condition Emergency Department Use Among Older Adults By www.jabfm.org Published On :: 2024-10-25T09:26:14-07:00 Background: The COVID-19 pandemic social distancing requirements encouraged patients to avoid public spaces including in-office health care visits. Ambulatory-care-sensitive conditions (ACSCs) represent conditions that can be managed with quality primary care and when access is limited, these conditions can lead to avoidable emergency department (ED) visits. Methods: Using national data on ED visits from 2019 to 2021 in the National Hospital Ambulatory Care Survey, we examined the impact of COVID-19 pandemic on ACSC ED visits among older adults (aged ≥65). Results: The proportion of ED visits among older adults that were for ACSCs increased between 2019 (17.4%) and 2021 (18.5%). The trend in both rural (26.4%–28.6%) and urban areas (15.4%–16.8%) shows a significant jump from 2019 to 2021 (P < .001). Conclusions: This rise in ACSC ED use is consistent with a delay in normal primary care during the pandemic. Full Article
la Reply to Letter to Editor Concerning “Nocturnal Pressure Controlled Ventilation Improves Sleep Efficiency in Patients Receiving Mechanical Ventilation” By rc.rcjournal.com Published On :: 2024-10-25T05:44:13-07:00 Full Article
la Nocturnal Pressure Support Ventilation: Truth or Dare? By rc.rcjournal.com Published On :: 2024-10-25T05:44:13-07:00 Full Article
la The Evolution of Intermittent Mandatory Ventilation: Update and Implications for Home Care By rc.rcjournal.com Published On :: 2024-10-25T05:44:13-07:00 Full Article
la Simulation in Mechanical Ventilation Training: Integrating Best Practices for Effective Education By rc.rcjournal.com Published On :: 2024-10-25T05:44:13-07:00 Full Article
la Effects of Lung Injury and Abdominal Insufflation on Respiratory Mechanics and Lung Volume During Time-Controlled Adaptive Ventilation By rc.rcjournal.com Published On :: 2024-10-25T05:44:12-07:00 BACKGROUD:Lung volume measurements are important for monitoring functional aeration and recruitment and may help guide adjustments in ventilator settings. The expiratory phase of airway pressure release ventilation (APRV) may provide physiologic information about lung volume based on the expiratory flow-time slope, angle, and time to approach a no-flow state (expiratory time [TE]). We hypothesized that expiratory flow would correlate with estimated lung volume (ELV) as measured using a modified nitrogen washout/washin technique in a large-animal lung injury model.METHODS:Eight pigs (35.2 ± 1.0 kg) were mechanically ventilated using an Engström Carescape R860 on the APRV mode. All settings were held constant except the expiratory duration, which was adjusted based on the expiratory flow curve. Abdominal pressure was increased to 15 mm Hg in normal and injured lungs to replicate a combination of pulmonary and extrapulmonary lung injury. ELV was estimated using the Carescape FRC INview tool. The expiratory flow-time slope and TE were measured from the expiratory flow profile.RESULTS:Lung elastance increased with induced lung injury from 29.3 ± 7.3 cm H2O/L to 39.9 ± 15.1cm H2O/L, and chest wall elastance increased with increasing intra-abdominal pressures (IAPs) from 15.3 ± 4.1 cm H2O/L to 25.7 ± 10.0 cm H2O/L in the normal lung and 15.8 ± 6.0 cm H2O/L to 33.0 ± 6.2 cm H2O/L in the injured lung (P = .39). ELV decreased from 1.90 ± 0.83 L in the injured lung to 0.67 ± 0.10 L by increasing IAP to 15 mm Hg. This had a significant correlation with a TE decrease from 2.3 ± 0.8 s to 1.0 ± 0.1 s in the injured group with increasing insufflation pressures (ρ = 0.95) and with the expiratory flow-time slope, which increased from 0.29 ± 0.06 L/s2 to 0.63 ± 0.05 L/s2 (ρ = 0.78).CONCLUSIONS:Changes in ELV over time, and the TE and flow-time slope, could be used to demonstrate evolving lung injury during APRV. Using the slope to infer changes in functional lung volume represents a unique, reproducible, real-time, bedside technique that does not interrupt ventilation and may be used for clinical interpretation. Full Article
la Effect of Fasting Prior to Extubation on Prevalence of Empty Stomach in Enterally Fed and Mechanically Ventilated Patients By rc.rcjournal.com Published On :: 2024-10-25T05:44:12-07:00 BACKGROUND:Practice on fasting prior to extubation in critically ill patients is variable. Efficacy of fasting in reducing gastric volume has not been well established. The primary objective of this study was to assess the effect of 4 h of fasting on prevalence of empty stomach using gastric ultrasonography in critically ill subjects who are fasted for extubation. The secondary objectives were to evaluate the change in gastric volumes during 4 h of fasting and to determine factors associated with empty stomach after fasting.METHODS:This was a single-center, prospective, observational study on adult ICU subjects who were enterally fed for at least 6 h continuously and mechanically ventilated. Gastric ultrasound was performed immediately prior to commencement of fasting, after 4 h of fasting, and after nasogastric (NG) aspiration after 4 h of fasting. An empty stomach was defined as a gastric volume ≤ 1.5 mL/kg.RESULTS:Forty subjects were recruited, and 38 (95%) had images suitable for analysis. The prevalence of empty stomach increased after 4 h of fasting (25 [65.8%] vs 31 [81.6%], P = .041) and after 4 h of fasting with NG aspiration (25 [65.8%] vs 34 [89.5%], P = .008). There was a significant difference in median (interquartile range) gastric volume per body weight between before fasting and 4 h after fasting (1.0 [0.5–1.8] mL/kg vs 0.4 [0.2–1.0] mL/kg, P < .001). No patient factors were associated with higher prevalence of empty stomach after 4 h of fasting.CONCLUSIONS:Most mechanically ventilated subjects had empty stomachs prior to fasting for extubation. Fasting for 4 h further increased the prevalence of empty stomach at extubation to > 80%. Full Article
la Invasive Mechanical Ventilation and Risk of Hospital-Acquired Venous Thromboembolism By rc.rcjournal.com Published On :: 2024-10-25T05:44:12-07:00 BACKGROUND:This study sought to estimate the overall cumulative incidence and odds of Hospital-acquired venous thromboembolism (VTE) among critically ill children with and without exposure to invasive ventilation. In doing so, we also aimed to describe the temporal relationship between invasive ventilation and hospital-acquired VTE development.METHODS:We performed a retrospective cohort study using Virtual Pediatric Systems (VPS) data from 142 North American pediatric ICUs among children < 18 y of age from January 1, 2016–December 31, 2022. After exclusion criteria were applied, cohorts were identified by presence of invasive ventilation exposure. The primary outcome was cumulative incidence of hospital-acquired VTE, defined as limb/neck deep venous thrombosis or pulmonary embolism. Multivariate logistic regression was used to determine whether invasive ventilation was an independent risk factor for hospital-acquired VTE development.RESULTS:Of 691,118 children studied, 86,922 (12.4%) underwent invasive ventilation. The cumulative incidence of hospital-acquired VTE for those who received invasive ventilation was 1.9% and 0.12% for those who did not (P < .001). The median time to hospital-acquired VTE after endotracheal intubation was 6 (interquartile range 3–14) d. In multivariate models, invasive ventilation exposure and duration were each independently associated with development of hospital-acquired VTE (adjusted odds ratio 1.64 [95% CI 1.42–1.86], P < .001; and adjusted odds ratio 1.03 [95% CI 1.02–1.03], P < .001, respectively).CONCLUSIONS:In this multi-center retrospective review from the VPS registry, invasive ventilation exposure and duration were independent risk factors for hospital-acquired VTE among critically ill children. Children undergoing invasive ventilation represent an important target population for risk-stratified thromboprophylaxis trials. Full Article